Pemphigus Vulgaris Mimicking Seborrheic Dermatitis: A Case Report.

Area of Science:

• Dermatology
• Immunodermatology

Background:

• Seborrheic dermatitis is a common scalp condition often presenting with pruritic, hyperkeratotic plaques.
• Accurate diagnosis is crucial as some conditions with similar clinical presentations can be life-threatening.

Observation:

• A 55-year-old patient presented with a chronic, painful, hyperkeratotic scalp plaque with thick, yellow scales.
• Initial treatment for suspected seborrheic dermatitis with ketoconazole, fluocinolone, mupirocin, and doxycycline was unsuccessful.

Findings:

• Punch biopsy and direct immunofluorescence revealed a final diagnosis of pemphigus vulgaris (PV).
• Pemphigus vulgaris is a rare autoimmune blistering disease that can present with diverse cutaneous manifestations.

Implications:

• This case highlights diagnostic challenges in dermatology due to overlapping clinical features of various scalp conditions.
• Persistent or treatment-resistant skin lesions warrant further investigation beyond initial clinical diagnosis.
• Timely and accurate diagnosis of pemphigus vulgaris is critical due to its potentially fatal nature.